Provider Demographics
NPI:1306302260
Name:EVOLUTION MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:EVOLUTION MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:727-216-3492
Mailing Address - Street 1:12454 81ST CT
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4409
Mailing Address - Country:US
Mailing Address - Phone:727-365-5126
Mailing Address - Fax:
Practice Address - Street 1:604 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3912
Practice Address - Country:US
Practice Address - Phone:727-365-5126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty